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Indigenous Health and Wellbeing: The Importance of …

Indigenous Health and wellbeing : The Importance of country Cynthia Ganesharajah Native Title Research Report Report No. 1/2009. April 2009. Indigenous Health and wellbeing : The Importance of country Cynthia Ganesharajah First published in 2009 by the Native Title Research Unit Australian Institute of Aboriginal and Torres Strait Islander Studies GPO Box 553. Canberra ACT 2601. The views expressed in this publication are those of the authors and not necessarily those of the Australian Institute of Aboriginal and Torres Strait Islander Studies. Copyright AIATSIS. Apart from any fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act 1968, no part of this publication may be reproduced without the written permission of the publisher.

Indigenous Health and Wellbeing: The Importance of Country Abbreviations and Acronyms ABS Australian Bureau of Statistics ALRA Aboriginal Land Rights (Northern Territory) Act 1976 (Cth) ICNRM Indigenous cultural and natural resource management

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1 Indigenous Health and wellbeing : The Importance of country Cynthia Ganesharajah Native Title Research Report Report No. 1/2009. April 2009. Indigenous Health and wellbeing : The Importance of country Cynthia Ganesharajah First published in 2009 by the Native Title Research Unit Australian Institute of Aboriginal and Torres Strait Islander Studies GPO Box 553. Canberra ACT 2601. The views expressed in this publication are those of the authors and not necessarily those of the Australian Institute of Aboriginal and Torres Strait Islander Studies. Copyright AIATSIS. Apart from any fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act 1968, no part of this publication may be reproduced without the written permission of the publisher.

2 NATIONAL LIBRARY OF AUSTRALIA. CATALOGUING-IN-PUBLICATION DATA: Ganesharajah, Cynthia, 1985- Indigenous Health and wellbeing : the Importance of country ISBN: 9780855756697 (pbk.). Aboriginal Australians. Torres Strait Islanders. Aboriginal Australians-- Health and hygiene. Torres Strait Islanders-- Health and hygiene. Aboriginal Australians--Social conditions. Torres Strait Islanders--Social conditions. Aboriginal Australians--Social life and customs. Torres Strait Islanders--Social life and customs. Commonwealth of Australia 2009. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth.

3 Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at Indigenous Health and wellbeing : The Importance of country Acknowledgements I would like to acknowledge the valuable guidance, contributions and comments of Dr Lisa Strelein and Dr Jessica Weir throughout the development of this research report. Thanks also to the anonymous peer reviewers for their comments. About the Author Cynthia Ganesharajah has recently completed a Bachelor of Science (Psychology) /. Bachelor of Laws (Hons) at the Australian National University. She is currently employed as the Publications Officer in the Native Title Research Unit at the Australian Institute for Aboriginal and Torres Strait Islander Studies.

4 The majority of this work was completed whilst undertaking an Aurora Project Native Title Internship in June-July 2008. i Indigenous Health and wellbeing : The Importance of country Abbreviations and Acronyms ABS Australian Bureau of Statistics ALRA Aboriginal Land Rights (Northern Territory) Act 1976 (Cth). ICNRM Indigenous cultural and natural resource management ILUA Indigenous Land Use Agreement IPA Indigenous Protected Area NAHS National Aboriginal Health Strategy NATSIS National Aboriginal and Torres Strait Islander Health Survey 2004-05. NTA Native Title Act 1993 (Cth). PBC Prescribed Body Corporate ii Indigenous Health and wellbeing : The Importance of country Contents 1. INTRODUCTION .. 1. 2.

5 WHAT IS Indigenous wellbeing ? .. 2. 3. SOCIAL DETERMINANTS OF Health : RECOGNISING THE Importance OF. 3. The poor state of Indigenous Health .. 4. country , Connection to country and 6. Early Research .. 7. Healthy country , Healthy People .. 9. 10. Autonomy .. 12. Physical Health Outcomes .. 13. 4. WHY HAS Indigenous Health NOT IMPROVED?.. 13. Uneconomic remote living perpetuates poor Indigenous Health .. 13. Health research must engage with the social determinants of 15. 5. OPPORTUNITIES FOR LIVING OR WORKING ON country .. 17. Living on 17. Land Rights .. 18. Native Title .. 20. Working on country .. 22. Caring for country Initiatives .. 24. 6. 25. 7. 27. 8. SELECTED ANNOTATED SUMMARY OF MATERIALS.

6 34. Land and Health .. 34. Social Determinants of Health .. 37. wellbeing .. 38. Natural Resource Management / Caring for country .. 39. Economic Perspectives .. 40. Outstations .. 41. Native Title .. 42. Comparative .. 42. Other .. 43. iii Indigenous Health and wellbeing : The Importance of country 1. INTRODUCTION. For Aboriginal people, land is not only our mother the source of our identity and our spirituality it is also the context for our human order and inquiry. 1. Our identity as human beings remains tied to our land, to our cultural practices, our systems of authority and social control, our intellectual traditions, our concepts of spirituality, and to our systems of resource ownership and exchange.

7 Destroy this relationship and you damage . sometimes irrevocably individual human beings and their Health . 2. A key aspect to improving Indigenous wellbeing is exploring the relationship between land and wellbeing . Evidence exists which suggests there are positive physical Health outcomes from living 3 or working on country . However, it has also been argued that Indigenous Health cannot improve whilst Indigenous peoples continue to live outside urban areas. 4 These competing views will lead to the adoption of very different strategies for addressing Indigenous Health issues. Therefore, it is critical to develop an understanding of the value of native title, the return of lands generally, or the capacity to live or work on country , to Indigenous peoples' wellbeing .

8 The aim of this paper is to provide an overview of relevant material. The central argument is that Indigenous Health strategies should take into consideration the Importance of connection to country to maximise their effectiveness. wellbeing is part of a holistic understanding of life. The Social and Emotional Well Being Framework, based on Aboriginal definitions of Health , recognises that a holistic and whole-of-life view of Health is essential to achieve positive life outcomes for Indigenous peoples. 5 Notions of Health are encompassed in the broader concept of wellbeing . Consequently, studies of the social determinants of Health are useful in considering influences on wellbeing . Broadly speaking there are two models of Health the biomedical model and the social determinants model.

9 The biomedical model of Health focuses on isolating the specific cause of illness. Medical research centres on the different levels of the human body and the way these interact in order to explain 1. Foundation for Aboriginal and Islander Research Action, Aboriginal people and the land' in Justin Healey (ed), Issues in Society, Vol 256, Native Title and Land Rights, 2007, , 1. 2. Pat Anderson, Priorities in Aboriginal Health ', in G. Robinson (ed) Aboriginal Health , social and cultural transitions: proceedings of a conference at the Northern Territory University, Darwin, 29-31. September, 1995, NTU Press, Darwin, 1996, , 3. See for example, Robyn McDermott, Kerin O'Dea, Kevin Rowley, Sabina Knight and Paul Burgess, Beneficial impact of the Homelands Movement on Health outcomes in central Australian Aborigines', Australian and New Zealand Journal of Public Health vol.

10 22, , 1998, 4. Helen Hughes and Jenness Warin, A New Deal for Aborigines and Torres Strait Islanders in Remote Communities', Issue Analysis , 2005. 5. Social Health Reference Group, Social and Emotional Well Being Framework a National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Well Being 2004-2009, report to the Department of Health and Ageing, Australian Government, Canberra, 2004. ( Social and Emotional Well Being Framework'). 1. Indigenous Health and wellbeing : The Importance of country illnesses. 6 Although this approach has been successful it is limited. In contrast, the social determinants of Health model focuses on societal structure and psychosocial factors, such as socioeconomic status, housing and gender.


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